Bracing & high tibial osteotomy: neuromuscular function

骨关节炎（OA）患者的本体感觉、肌肉质量和力量常常受损。据报道，使用氯丁橡胶套可以改善正常和关节炎患者的本体感觉。市场上已经有其他的支架通过机械地卸载关节炎膝关节间室来减轻疼痛，从而提供了重新对准截骨术的优点，而没有手术风险或费用。然而，这些支架对本体感觉的影响尚不清楚。如果氯丁橡胶套能显著改善本体感觉和膝关节稳定性，那么氯丁橡胶套和定制卸载支具之间的成本差异可能是合理的。通常，对内侧间室OA患者进行胫骨高位截骨术（HTO）手术，以纠正机械对线、缓解疼痛和恢复功能。 本研究的目的是评估两种支架（即，氯丁橡胶套管和内侧卸载器支具）以及使用HTO进行下肢畸形的手术矫正。 将对这些治疗方案进行前瞻性研究，以评估膝关节单侧内侧间室OA患者的神经肌肉功能。将招募20名年龄在30至55岁之间、同意接受HTO手术的患者。将在术前和术后评价体格检查和影像学检查，沿着经确认的患者结局指标。在术前和术后6个月时进行神经肌肉功能评估，两种情况下均不使用支具，同时佩戴氯丁橡胶袖套和内侧减压支具。将通过测量四个因变量来测试每种支具对神经肌肉功能的影响：1）本体感觉（即，检测被动运动和再现主动/被动定位的能力）; 2）在跑步机行走期间四头肌的肌电图活动; 3）单腿站立期间的平衡测试;和4）四头肌和腿筋肌肉的等速力量测试。还将使用经验证的结局指标和视觉模拟疼痛量表评估缓解疼痛与神经肌肉功能之间的关系。据推测，与无支撑的膝关节状况相比，支撑和HTO将显著改善本体感觉、股四头肌活动、平衡和力量。在这些治疗中，HTO有望在疼痛和神经肌肉功能方面提供最大的改善。 通过比较HTO手术前后氯丁橡胶袖套和内侧卸荷器支具的效果，我们将深入了解支具的效果，并更好地理解HTO在内侧间室OA治疗中的作用。此外，尚未探索治疗后疼痛缓解对膝关节本体感觉的影响。 了解支具和手术对这一重要关系的影响，对这些患者的治疗和康复具有重要意义。

Proprioception, muscle mass, and strength are o ten impaired in patients with osteoarthritis (OA). Use of a neoprene sleeve has been reported to improve proprioception in both normal and arthritic patients. Other braces have been marketed to relieve pain by mechanically unloading an arthritic knee compartment, thereby providing the advantages of realignment osteotomy without the surgical risk or expense. However, the effect of these braces on proprioception is unknown. The substantial difference in cost between a neoprene sleeve and custom unloading brace may be justified if it significantly improves proprioception and knee stability. Often, high tibial osteotomy (HTO) surgery is performed in patients with medial compartment OA to correct mechanical alignment, alleviate pain, and restore function. The objective of this study is to evaluate the effects of two braces (i.e., neoprene sleeve and medial unloader brace) as well as surgical correction of lower limb deformity with HTO. A prospective study of these treatment options will be undertaken to assess neuromuscular function in patients with unilateral medial compartment OA of the knee. Twenty patients between 30 and 55 years of age who have consented to receive HTO surgery will be recruited. Physical and radiographic exams will be evaluated pre- and post-operatively, along with validated patient outcome measures. Assessments of neuromuscular function will be made pre-operatively and at 6 months post-operatively, both without bracing and while wearing a neoprene sleeve and a medial unloader brace. The effects of each brace on neuromuscular function will be tested by measuring four dependent variables: 1) Proprioception (i.e., ability to detect passive motion and reproduce active/passive positioning); 2) Electromyographic activity of the quadriceps during treadmill walking; 3) Balance testing during single leg stance; and 4) Isokinetic strength testing of the quadriceps and hamstring muscles. The relationship between alleviating pain and neuromuscular function will also be assessed using validated outcome measures and visual-analogue pain scales. it is hypothesized that bracing and HTO will significantly improve proprioception, quadriceps muscle activity, balance and strength compared to the unbraced knee condition. Of these treatments, HTO is anticipated to provide the greatest improvements in pain and neuromuscular function. By comparing the effects of the neoprene sleeve, and the medial unloader brace, both before after HTO surgery, we will obtain insight on the effects of bracing and a greater understanding of the role of HTO in the treatment of medial compartment OA. Furthermore, the effect of pain alleviation on knee proprioception following treatment has not been explored. Understanding the effect of braces and surgical realignment on this important relationship should have significant implications for the treatment and rehabilitation of these patients.